Augmentative and Alternative Communication (AAC) in Autism

Source: Iacono, T., Trembath, D., & Erickson, S. (2016). The role of augmentative and alternative communication for children with autism: current status and future trends. Neuropsychiatric Disease and Treatment, 12, 2349. Supplemented by Autism Ontario, Autism Society of NC, Vanderbilt TRIAD, and the National Autistic Society. Evidence level: Tier 1 — Systematic Review / Meta-Analysis Domain: Communication

• AAC is effective for autistic children. A systematic review of 17 separate research reviews found that AAC is effective to highly effective at helping autistic children communicate — particularly for learning to make requests, which is often the first step in building communication skills.
• Using AAC does not hold back speech development. Research consistently shows that introducing AAC does not slow down or prevent a child from developing spoken language. In fact, growing evidence suggests it can support speech alongside other communication skills.
• Around 25–50% of autistic children do not develop functional spoken communication, meaning many children stand to gain greatly from AAC — the earlier it is introduced, the better. Waiting to see if speech develops on its own is considered unnecessary and ethically problematic by specialists in this field.
• AAC can reduce frustration and challenging behaviour. When a child gains a reliable way to express their wants and needs, research shows a meaningful reduction in distress and behaviours that can arise from communication difficulties.
• There is no single "best" AAC system. Options range from no-tech (gestures, signs) to low-tech (picture boards) to high-tech (speech-generating devices and apps). The right choice depends on the individual child's strengths, motor skills, environment, and the people around them. The Picture Exchange Communication System (PECS) currently has the strongest research base among specific AAC methods.

• You don't have to wait. If your child is finding spoken communication difficult, you can explore AAC now. Research supports offering communication tools early rather than holding off to see if speech develops — both approaches can happen at the same time.
• Everyone around your child has a role. AAC works best when the people in a child's life — parents, siblings, teachers, and support workers — all use and model it throughout the day, not just during therapy sessions. This is sometimes called "aided language stimulation," and even small moments of modelling make a real difference.
• Think beyond the device. Even if your child uses a high-tech device as their main communication tool, it helps to also build some low-tech or no-tech skills (like gestures or a simple picture board) for situations where the device isn't practical — like at the swimming pool or on a busy playground.
• Ask about a proper assessment. A speech-language pathologist (SLP) or AAC specialist can help match your child to the system that fits them best, taking into account their motor skills, learning style, and daily environments. Insurance or funding support may also be available for devices.

• The research quality is variable. While the overall direction of the evidence is positive, the systematic review found that many individual studies had design limitations, making it hard to draw firm conclusions for every child or every AAC system. Results for high-tech speech-generating devices, in particular, depend heavily on how much training and ongoing coaching is provided.
• Up to 60% of AAC systems are abandoned. Research from Autism Ontario highlights that a device or system on its own is not enough — without consistent training, support, and follow-up from a qualified team, many AAC tools are set aside. Ongoing commitment from families and professionals is essential.
• Some promoted "communication" methods are not safe. Facilitated Communication, Rapid Prompting Method, and Spelling to Communicate are not evidence-based and have been associated with serious harms. Professional bodies including the American Speech-Language-Hearing Association have issued formal warnings against them. Always consult a qualified clinician before starting any communication programme.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5036660